Division of Oncological and Robotic General Surgery, Careggi University Hospital.
Department of Surgery and Translational Medicine, Hepatobiliary Surgery Unit, University of Florence, Florence, Italy.
Surg Laparosc Endosc Percutan Tech. 2021 Jan 21;31(4):468-474. doi: 10.1097/SLE.0000000000000904.
Minimally invasive approaches are spreading in every field of surgery, including liver surgery. However, studies comparing robotic hepatectomy with the conventional open approach regarding oncologic outcomes for hepatocellular carcinoma are limited.
We retrospectively reviewed demographics characteristics, pathologic features, surgical, and oncological outcomes of patients who underwent robotic and conventional open liver resection for hepatocellular carcinoma.
No significant differences in demographics features, tumor size, tumor location, and type of liver resection were found. The morbidity rate was similar, 23% for the open group versus 17% of the robotic group (P=0.605). Perioperative data analysis showed a greater estimated blood loss in patients who underwent open resection, if compared with robotic group (P=0.003). R0 resection and disease-free resection margins showed no statistically significant differences. The 3-year disease-free survival of the robotic group was comparable with that of the open group (54% vs. 37%; P=0.592), as was the 3-year overall survival (87% vs. 78%; P=0.203).
The surgical and the oncological outcomes seem to be comparable between minimally invasive and open hepatectomy. Robotic liver resections are effective, and do not compromise the oncological outcome, representing a reasonable alternative to the open approach.
微创技术在外科的各个领域都在不断发展，包括肝脏外科。然而，关于机器人肝切除术与传统开腹手术在肝细胞癌的肿瘤学结果方面的比较研究有限。
我们回顾性分析了接受机器人和传统开腹肝切除术治疗肝细胞癌的患者的人口统计学特征、病理特征、手术和肿瘤学结果。
两组患者的人口统计学特征、肿瘤大小、肿瘤位置和肝切除术类型均无显著差异。开放组和机器人组的发病率相似，分别为 23%和 17%（P=0.605）。围手术期数据分析显示，开放组的估计出血量明显多于机器人组（P=0.003）。R0 切除和无病切缘率无统计学差异。机器人组的 3 年无病生存率与开放组相当（54% vs. 37%；P=0.592），3 年总生存率也相当（87% vs. 78%；P=0.203）。
微创与开腹肝切除术的手术和肿瘤学结果似乎相当。机器人肝切除术有效，并不影响肿瘤学结果，是开放手术的合理替代方法。
